100%(1)100% menganggap dokumen ini bermanfaat (1 suara)
72 tayangan93 halaman
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Judul Asli
Biology of Tooth Movement-Ortho / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
www.indiandentalacademy.com www.indiandentalacademy.com BIOLOGY OF TOOTH Periodontium Periodontium is a connective tissue organ covered by epithelium , that attaches the teeth to the bones of the jaws and provides a continually adapting apparatus for support of teeth during function. 4 connective tissues Two mineralized -Cementum -Alveolar bone Two fibrous -Periodontal ligament -Lamina propria of the gingiva. www.indiandentalacademy.com Cells Progenitor cells Synthetic cells a) Osteoblasts b) Fibroblasts c) Cementoblasts Resorptive cells A) Osteoclasts B) Fibroblasts C) Cementoclasts
www.indiandentalacademy.com Extra cellular elements Fibres -Collagen -Oxytalan Ground Substance -Proteoglycans -Glycoproteins
www.indiandentalacademy.com Principle Fibres of the Periodontal Ligament(Collagen Fibres) 1. Alveolar crest group 2. Horizontal group 3. Oblique group 4. Apical group 5. Interradicular group www.indiandentalacademy.com GINGIVAL FIBRES 1. Circular 2. Alveologingival 3. Dentoperiosteal 4. Dentogingival 5. Transseptal fibres(Accesory fibres) www.indiandentalacademy.com Alveolar bone
Two parts 1. Alveolar bone proper 2. Supporting alveolar bone A.- Cortical Plate B.- Spongy Bone Alveolar process is formed by intramembranous ossification. They can be remodelled owing to the structure.
www.indiandentalacademy.com Active stabilization of teeth against forces of low magnitude www.indiandentalacademy.com Response to normal function: Forces applied on the teeth are- 1-2 kgs when soft Upto 50 kgs against harder food
www.indiandentalacademy.com TOOTH MOVEMENT- Application of orthodontic force tooth movement on account of resorption on the pressure side and deposition on the tension side. www.indiandentalacademy.com www.indiandentalacademy.com Cascade of activities- Tooth movement (Norton) www.indiandentalacademy.com Classification of orthodontic forces- Schwartz
Four degrees of biologic efficiency. 1 st Below threshold stimulus. 2 nd -Most favourable 15-20 gms per square cm.Less than the blood pressure. 3 rd -Medium strength.They stop the blood. flow.Tissues are not crushed. 4 th Forces are so high that the tissues are crushed. Irrepairable damage may be caused to the tissues involved. www.indiandentalacademy.com Theories of orthodontic tooth movement 1) Bioelectric theory -electric signals produced when alveolar bone flexes and bends. Also called the piezoelectric theory.
2) Pressure tension theory(Schwartz1932)-related to cellular changes produced by chemical messengers.
Bien Hydrodynamic damping of tooth movement, J. D. - 1966.
Theories are mutually dependent. www.indiandentalacademy.com Bioelectric theory 2 unusual characteristics- 1. -quick decay rate 2. -equivalent signal opposite direction www.indiandentalacademy.com Crystal deformation-electrons migrate due to distortion of cross linkages between the collagen fibres in the bones. Electropositive response (convexity) resorption Electronegetive (concavity) -deposition Ions in fluids bathe the bone and cause streaming potential. Similar but not the same. No place in natural control of body.
Bioelectric theory www.indiandentalacademy.com Bioelectric theory Stress generated signals important- astronauts.(can also be explained OB differentiation) Chewing /orthodontic forces. Bioelectric signals-active growth, not exactly known. Exogenous signals modify tooth movement-lag phase before tooth movement. www.indiandentalacademy.com Effect of Pulsed Electromagnetic Field on Tooth Movement- Stark and Sinclair Ajo - 1987 Feb Simple non invasive pulsed electromagnetic (25-Hz) field can cause an effect on the rate and amount of tooth movement. 20-experimental,20-control Guinea pigs
AFTER 10 DAYS Tooth movement Osteoclast cell count www.indiandentalacademy.com www.indiandentalacademy.com Observations- 1. Protein metabolism indicated by creatinine ,craetinine phosphokinase, uric acid.
2. Na Ca K which are postulated to be the effect of pulsed electromagnetic stimulation on the cell membrane are not increased.
3. Exciting possibily for future consideration - Ability to initiate and enhance the bone deposition-use with functional appliances.
www.indiandentalacademy.com Effect of Pulsed Electromagnetic Field on Tooth Movement- Stark and Sinclair Ajo - 1987 Feb PRE AND POST EXPERIMENT
www.indiandentalacademy.com CONTROL AND EXPERIMENTAL GROUP
www.indiandentalacademy.com INCREMENTAL MOVEMENT www.indiandentalacademy.com www.indiandentalacademy.com Structure of the bone
www.indiandentalacademy.com Pressure -Tension Theory Relies on chemical signals and not electrical signals for cellular differentiation and tooth movement.
www.indiandentalacademy.com Cells causing remodeling of bone 1. OB 2. OC
ORIGIN OF THE CELLS
1) OB-Neural crest cells(OB)- Pre Osteoblasts
a) Contact inhibition.
b) G1,G2 blocked cells.
www.indiandentalacademy.com Differentiation of cells under mechanical influence www.indiandentalacademy.com Differentiation of cells under mechanical influence www.indiandentalacademy.com Differentiation of cells under mechanical influence www.indiandentalacademy.com 2) OC- Hematogenous in origin Monocytes have been suggested to be the predecessors. Progenitors ??? Blocked cells local preosteoclasts & circulating preosteoclasts. Cells causing remodeling of bone www.indiandentalacademy.com Differentiation of cells under mechanical influence-OB & OC www.indiandentalacademy.com Vit D metabolites They are known to effect bone formation and deposition via the differentiation of the comitted progenitor cells into mature cells.
www.indiandentalacademy.com OSTEOBLASTS RESORPTIVE FUNCTION 1) OB-Physical barrier-layer of cells on the bone surface. If these cells are stimulated by PTH they change shape (round) thus exposing the underlying mineral of the tooth only affects already differentiated cells. .
www.indiandentalacademy.com Shape change in cells: mechanism for the transduction of mechanical forces ( Sandy- Bdj;1992) Relationship exists bw cell shape and metabolic activity. Flattened cells synthesize more DNA than rounded cells. PG and PTH induce change in shape. Suggested in pressure sites the cells are rounded and have catabolic effects-tension sites the cells are flattened and in a synthetic mode. www.indiandentalacademy.com RESORPTIVE FUNCTION 2) Release certain mediators cytokines-Bring about osteoclastic resorption. They are defined as short range soluble mediators,released from the cells which modulate the activity of other cells - ( Bone remodeling- Sajeda Meghji 1992; Bdj ) - lymphokines.
OSTEOBLASTS www.indiandentalacademy.com Cytokines:Mediators of bone remodeling( -Sandy- Bdj;1992 -Biology of tooth movement- Norton and Burstone)
Osteoclasts dont work independently -signal transmitted to the osteoclast by an Osteoblast Cytokine.
www.indiandentalacademy.com RESORPTIVE FUNCTION 3)Osteiod layer covering the bone is removed by OB - secrete collagenase. P TIMP
Cytokines:Mediators of bone remodeling ( Sandy- Bdj;1992,-Biology of tooth movement- Norton and Burstone) TIMP-TISSUE INHIBITOR OF METTALOPROTEINASES
www.indiandentalacademy.com FORMATIVE-
1)Pressure 2)Production of first messenger( physical/ chemical)
a) Deformation may lead to ca influx b) Hormones(PTH) c) Prostaglandins( macrophages ) d) Neurotransmitters(SP)
OSTEOBLASTS They bind to the cell surface receptors.
www.indiandentalacademy.com 3)Second messengers a. c AMP b. c GMP c. Ca 4)Increased bone activity
OSTEOBLASTS www.indiandentalacademy.com
www.indiandentalacademy.com Trans membrane signaling pathway PHOSPHOINOITIDASE INOSITOL TRIPHOSOHATE www.indiandentalacademy.com Discovered by VON EULER 1934 Prostate gland Yamasaki injection of exogenous PG increased osteoclast numbers.
Role of Prostaglandins (Tooth eruption and orthodontic movement:Sandy-Bdj,1992) Phospholipids phopholipase Arachidonic acids
Prostaglandin's
c AMP
Ca+2 www.indiandentalacademy.com
ARACHIDONIC ACID METABOLISM www.indiandentalacademy.com Leukotrienes and HETE (Leucocytes) (Hydroxyeicosatetraenoic Acid) , produced from the same substrate.
Since PGs do not fully account for bone remodeling associated with tooth movement , lipoxygenase products may be involved. www.indiandentalacademy.com OSTEOCLASTS Resorptive action PTH- systemic factor Cytokines Mechanical Ruffled border Lysosomal enzymes www.indiandentalacademy.com Osteocytes cytoplasmic processes which help to gauge the pressure changes and signal the OB.
Osteocytes
www.indiandentalacademy.com Events during bone remodelling www.indiandentalacademy.com PDL and bone response to sustained forces on pressure side-
1. Undermining resorption
2. Fontal resorption www.indiandentalacademy.com Oteoclast differentiation 2 waves -1 st wave local cell population. -2 nd wave-blood flow. Optimal force-frontal resoption on pressure side Excess force would cause undermining resorption. www.indiandentalacademy.com Pattern of bone deposition and resorption www.indiandentalacademy.com Tooth movement Tooth movement may be divide into (Graber .Vanarsdall) - Initial Undermining resorption - Secondary period-Frontal resorption
Initial phase- 3 main stages 1. Degeneration 2. Elimination of destroyed tissue 3. Establishment of new attachment www.indiandentalacademy.com 1.Degeneration 1. Blood flow 2. Degradation of vessel walls 3. Cellular changes -Swelling of mitochondria -Rupture of cytoplasmic membrane leaving only isolated nuclei between the fibrous elements The source of cells which differentiate into osteoclasts is lost. Area is cell free. Glassy appearing sterile necrotic area caused due to excessive pressure application -HYALINIZATION
Tooth movement www.indiandentalacademy.com Tooth movement 2.Elimination of destroyed tissue Adjacent undamaged areas give rise to the osteoclasts (multinucleated giant cells) which cause remodeling of the bone on the peripheral areas.
Invasion of the hyalinized areas by the cellular elements.
Adjacent alveolar bone-undermining resorption 3.Establishment of new attachment Synthesis of new tissue once the hyalinized tissue is removed - Fibroblasts.
www.indiandentalacademy.com Macrophages adjacent to hyalinized areas www.indiandentalacademy.com Tooth movement In secondary phase Osteoclasts differentiate and cause frontal resorption. Osteoblasts deposit on the tension surface. On the tension side resorption occurs on the spongiosa surface of the alveolar bone. On pressure apposition takes place on the spongiosa surface. Remodelling also takes place on the on the periosteal surface of the bone - helps to maintain the thickness of the alveoar bone. www.indiandentalacademy.com Differential Time Course Bw Frontal and Undermining Resorption www.indiandentalacademy.com Initial loading leads to some amount of tooth movement- movement increases with time-light forces. Movement takes place in a stepwise fashion with heavy forces. Differential Time Course Bw Frontal and Undermining Resorption www.indiandentalacademy.com Effects of Tooth Movement and Force Distribution Distribution of forces and tooth movement differ depending upon the type of tooth movement. Tipping -Forces used to tip the teeth must be kept low 50gms. www.indiandentalacademy.com Effects of Tooth Movement and Force Distribution Tipping-hyalinization Caution -alveolar crest. www.indiandentalacademy.com Effects of Tooth Movement and Force Distribution Bodily tooth movement-uniform loading of the teeth is seen. . www.indiandentalacademy.com Bodily tooth movement
Slight tipping due to the hyalinized zone formed and resorption adjacent to it. Further tipping prevented by the stretch of the fibres.
Effects of Tooth Movement and Force Distribution www.indiandentalacademy.com Rotation Practically impossible to bring about pure rotation tipping is the actual mechanism 2 pressure sites and 2 tention sites.usually 1 side shows frontal and other undermining resorption.After 3-4 weeks frontal resorption prevails. Supracrestal fibres-gingival fibres, trans gingival fibres. Long retention period, supracrestal fibrotomy. Effects of Tooth Movement and Force Distribution www.indiandentalacademy.com TRANSSEPTAL FIBRES
www.indiandentalacademy.com Effects of Tooth Movement and Force Distribution Intrusion light forces are actually needed for intrusion as the forces are highly concentrated over a very small area. If bone compact as in adults-interrupted force maybe better. allows time for cell proliferation. Gingival fibres are relaxed - cause formation of bony spicules - crestal areas.
www.indiandentalacademy.com Effects of Tooth Movement and Force Ditribution(Proffit) 1. Tipping 35-60gms 2. Bodily 70-120gms 3. Uprighting 50-100gms 4. Rotation 35-60gms 5. Extrusion 10-20gms 6. Intrusion-10-20gms
www.indiandentalacademy.com Effects of force duration and decay Duration the second messenger produced only after 4 hours. Forces 1. Continuous 2. Interrupted light and heavy 3. Intermittent
www.indiandentalacademy.com Force Duration and Decay Ideal to have light continuous forces but heavier forces can be allowed if a period of regeneration and repair is allowed. 4 week appointment cycle. www.indiandentalacademy.com Force Magnitude(Heavy pressure) www.indiandentalacademy.com Force Magnitude(Light pressure) www.indiandentalacademy.com AJO-DO 1985 Step Reassessment of force magnitude - Quinn and Yoshikawa Modifying the force magnitude as suggested by Storey and Smith www.indiandentalacademy.com Pressure Versus Response pressure - movement Platue Decline at the end Optimum force- lightest force producing maximum or near maximum movement www.indiandentalacademy.com Pressure Versus Response A1-anchor teeth M1- teeth to be moved
www.indiandentalacademy.com Stationary anchorage Bodily versus tipping movement- anchor teeth would move less but if the force is really high enough to bring posterior teeth into optimum movement rage they would move the same amount. Large forces www.indiandentalacademy.com Drug Effect on the Response of Orthodontic Forces +ve effect PG -ve effect 1. Bisphosphanates-act as specific inhibitors of osteoclast mediated bone resorption. 2. PG inhibitors NSAIDS, indomethacin , tricyclic antidepressants,anti arrhythmic agents,anti malarial drugs, methyl xanthines. 3. Corticosteroids (reduce the inflamation) www.indiandentalacademy.com Phospholipids phopholipase Corticosteroids Arachidonic acids NSAIDS Prostaglandins
Drug Effect on the Response of Orthodontic Forces www.indiandentalacademy.com The effect of acetaminophen on tooth movement in rabbits - 1997 Angle Orthodontist John J. Roche et al It is a weak prostaglandin inhibitor - recommended for use to relieve pain during orthodontic tooth movement. 14 rabbits were used. Lower first molar and incisor teeth on one side were prepared with a perforation hole buccolingually. Maxilla was excluded from the study-21-day period. Over the 21 day period, each rabbit was force-fed 1000 mgs of Tylenol (10 ml of solution) per day
www.indiandentalacademy.com
www.indiandentalacademy.com On day 21, the rabbits were sacrificed Impressions of the final interdental distance were obtained and poured in stone for future examination.
Acetaminophen does not seem to retard orthodontic tooth movement, related to its lack of anti-inflammatory properties
Concentrated in the central nervous system The effect of acetaminophen on tooth movement in rabbits -1997 Angle Orthodontist John J. Roche, George J. Cisneros, George Acs.
The effect of acetaminophen on tooth movement in rabbits - 1997 Angle Orthodontist John J. Roche, George . Cisneros, George Acs.
www.indiandentalacademy.com Role Of Prostaglandins In Orthodontic Tooth Movement- Dr Anand Patil 1microgram (gm) / injection (inj) of PG-E1 along with lignocaine as a vehicle was injected on three different days in the vestibular region distal to the right upper canine in 15 Patients.
The left side was the controlled side with injection of vehicle alone.
Occlusograms of pre and 60 days post canine retraction was obtained and distal canine movement was calculated by using stable land marks such as 1st rugae area .
The results showed statistically significant 57% increase in orthodontic distal canine tooth movement on prostaglandin injected side as compared with matched controlled left side. www.indiandentalacademy.com Pre & post Retraction Occlusograms www.indiandentalacademy.com AJO-DO 1983 Jan (62-75): Histochemistry of enzymes associated with tissue degradation incident to orthodontic tooth movement - Lilja, Lindskog, and Hamm
www.indiandentalacademy.com www.indiandentalacademy.com A tipping movement had been produced by the orthodontic forces, and thus two pressure zones- buccal and lingual.
Acid phosphatase activity Cells randomly distributed along the bone surface in the alveoli in non treated cases.
Prostaglandin synthetase - found exclusively in the bone marrow-not in PDM. AJO-DO 1983 Jan (62-75): Histochemistry of enzymes associated with tissue degradation incident to orthodontic tooth movement - Lilja, Lindskog, and Hamm
www.indiandentalacademy.com
Low force - rapid redistribution to the pressure zones of cells with a high acid phosphatase activity.
Accompanied by a high enzyme activity in the adjacent osteocytes.
Low forces caused no change in the distribution and activity of LDH at any time during the treatment.
After 1 day of high force a zone devoid of LDH activity developed in the buccal pressure zone
No change in the activity of this enzyme was found in the bone marrow during the treatment
AJO-DO 1983 Jan (62-75): Histochemistry of enzymes associated with tissue degradation incident to orthodontic tooth movement - Lilja, Lindskog, and Hamm